中山医院结直肠癌MDT讨论治疗策略分析

目的分析结直肠癌多学科诊疗团队（MDT）讨论后制定的治疗策略。 方法回顾性分析2010年7月至2019年2月复旦大学附属中山医院进行MDT讨论的结直肠癌患者的临床资料，对MDT讨论结果进行统计分析。 结果结直肠癌MDT总计为1 953例结直肠癌患者进行4 535人次讨论制定个体化治疗方案。其中，553例患者肝转移灶和111例患者肺转移灶被认为可切除。另有261位最初不可切除的结直肠癌肝转移患者，在接受系统化疗联合分子靶向以及介入等综合治疗后，转化为可切除，建议接受肝转移灶切除手术。实际上总计772位结直肠癌患者接受肝转移灶切除，其中同时性肝转移患者有581例，而接受结直肠癌原发灶和肝转移灶同步切除的患者有248例。肝切除手术中仅有87例患者（11.3%）实施解剖性肝切除，绝大多数实施非解剖性肝切除。肝转移灶切除手术中联合射频消融的有62例（8.0%）。术后病理提示R1切除的有18位（2.3%）。 结论复杂结直肠癌病例推荐行MDT讨论。扩展手术适应证、应用二步肝切除术、联合射频消融等局部毁损治疗可以扩大肝转移灶手术的适应人群。初始无法手术切除的患者，如状况耐受，建议给予强烈的个体化转化治疗，争取转化后手术切除。

Analysis of treatment strategy after colorectal cancer MDT discussion in Zhongshan Hospital

ObjectiveTo explore the role of multidisciplinary team (MDT) in the diagnosis and treatment of patients with colorectal cancer. MethodsA retrospective analysis of CRC patients who underwent MDT discussions from July 2010 to February 2019 at Zhongshan Hospital, Fudan University was conducted and analyzed. ResultsA total of 4 535 MDT discussions developed individualized treatment regimens for 1 953 patients with CRC. Among them, 553 patients with liver metastases and 111 with lung metastases were considered to be resectable. Moreover, 261 patients with initially unresectable colorectal liver metastases were converted to resectable after receiving comprehensive treatment. Actually a total of 772 patients underwent hepatectomy, including 581 patients with synchronous liver metastases, and 248 patients received simultaneous resection of primary colorectal cancer and liver metastases. Only 87 patients (11.3%) underwent anatomical hepatectomy, while the vast majority performed non-anatomical hepatectomy. Sixty-two patients (8.0%) underwent hepatectomy combined with intraoperative radiofrequency ablation. Postoperative pathology results revealed 18 (2.3%) cases of R1 resection. ConclusionMDT discussion is recommended for patients with complex CRC. Expanding surgical indications, applying two-step hepatectomy, and combination with radiofrequency ablation can expand the population who underwent metastases surgery. For patients with initially unresectable metastases, it is recommended to perform strong individualized conversion therapy for secondary surgical resection if fit.